Dermal Science General Notes

History taking:

Expectations

Lifestyle factors

Expense

Potential complications

Skin type and skin condition

Skin care regime:

l   AM

n   Cleanse

n   Tyrosinase inhibitor

n   Vitamin C

n   Vitamin B

n   Moisturiser/eye cream

n   SPF

n   Foundation

l   PM

n   Cleanse

n   TI

n   Vitamin A 3^rd nightly

n   AHA 2x/week

n   Moisturiser/ eye cream

Fitzpatrick assessment:

l   Ethnicity: up to grandparents

l   Natural hair & eye colour

l   Tanning: eg. Red then tan? Red but doesn’t tan etc.

l   Non-exposed area: eg. Breast

l   PIHP: Healing from wounds and scratches, is it light pink or dark brown?

Acne grading:

Acne Grade	Characteristics	Treatments
I	Acne with few or a lot of comedones with little or no inflammation.	Self-treatment or with single topical agent such as topical retinoids/ benzoyl peroxide/ clindamycin/ erythromycin.
II	Acne with comedones and small superficial pustules and inflammatory lesions in the follicle.	Single or combination topical agent such as topical retinoids/ benzoyl peroxide/ clindamycin/ erythromycin.
III	Acne consisting of comedones, small pustules and tendency to deeper inflammatory lesions.	Oral tetracycline antibiotics or oral contraceptives.
IV	Extensive secondarily infected cystic acne. Confluent lesions with canalised sinuses.	Oral retinoids, Once the infections and cysts have resolved, microdermabrasion/ peels/ laser resurfacing are options to help smooth the scars.

Infrared, Radiofrequency and LED technology:

Technology	Main Wavelengths utilised	Main mechanism of action	Indications	Commercial brand names available
RF	1mm – approx.3km	RF energy generates heat when it meets impedance (resistance) in the tissues. This controlled volume of heat when distributed in the deep dermis creates a dual effect: Primarily, heat disrupts hydrogen bonds of the triple helix collagen molecule, altering its molecular structure, resulting in collagen contraction (shrinkage). Secondary, due to the response to wound healing, a more gradual contraction occurs over time as collagen regenerates and thickens the dermis. This results in a tighter and firmer looking skin creating a ‘lift’ and reducing lines and wrinkles.	• Fine lines/wrinkles • Shrinking, sculpting or destroying tissues: Skin tightening, Body contouring, Cellulite reduction	• Syneron, ELOS® • Thermage, Thermacool® • Alma, Accent® • Lumenis, Aluma!" • Radiosurgery
Infrared	760nm - 10,000nm	Non-ablative. Deep dermal heating (of approx. 60 - 70°C) causes an immediate collagen shrinkage due to the breakage of hydrogen bonds linking the protein stands together. This structural change to collagen creates an immediate and noticeable change to skin laxity	• Skin laxity (both face and neck) • Crepe skin • Fine lines/wrinkles • Post-pregnancy tummy • Atrophic acne scarring • Good option for patients who can’t have downtime • Good option for non-facial areas	• Titan by Cutura - spectrum of 1100 to 1800nm • Harmony Platform by Aluma Lasers (ST handpiece) - spectrum of 800nm to 1000nm • Starlux by Palomar - (IR fractional handpiece) - 850nm to 1350nm • Infrared lasers - Diode, Nd: YAG, Erbium, CO2
ELOS	Some devices use non-laser light source (580–980 nm) for optical energy, whereas others use a high-power diode laser (900 nm) as its light source	Combines radiofrequency and visible light (optical) energy in the form of laser, IPL or infrared. Theory behind ELOS is that RF enables a reduction of optical energy output (fluence) allowing treatment of all skin types and possibly light hair.	• Fine lines/wrinkles • Shrinking, sculpting or destroying tissues: Skin tightening, Body contouring, Cellulite reduction	• Syneron, ELOS®
LEDs	from approximately 400 nanometers to over 1500 nanometers	LED’s impact described as generating the mitochondrial energy of the cell. Energy increase reverberates through multiple cell functions and processes, effecting tissue repair and regeneration. Action is likened to the response of chlorophyll within plant, converting sunlight to cellular building blocks.	Cosmetic: • General skin rejuvenation • Erythema (facial flushing and telangiectasia) • Acne • Dyschromia (melasma, solar lentigines, freckles) • Poikiloderma • Scar reduction • Cellulite • Hair growth stimulation Therapeutic: • Psoriasis • Dermatitis and eczema • Rosacea • Actinic keratosis (combined with PDT) • Non-melanoma cancerous lesions (combined with PDT)	Omnilux Blue Omnilux Revive Omnilux Plus

Washing the face:

1.          Protect client’s hair with cap.

2.          Put a gloves.

3.          Prepare a bowl of warm water with a facial wipe ripped in half (eg. Sofeel facial wipes).

4.          Put water and cleansing agent (eg. Aspect deep clean), mix to create foam and massage onto face. Then wipe off with damp face wipe. Repeat again if there’s make up.

5.          Dry hands with towel. Dry client’s face.

6.          Use alcohol wipe to further clean the face.

End of procedures care:

Apply Aspect vitamin B & redless, and Synergie Uberzinc.